Cerebral Edema in Pediatric Diabetic Ketoacidosis

Purpose:

The purpose of this trial is to compare two different rates of fluid administration during
diabetic ketoacidosis (DKA) treatment in children to determine which fluid administration
rate is more beneficial for brain metabolism and for preventing or decreasing brain swelling
during DKA.

Study summary:

Cerebral edema (swelling of the brain) is the most frequent serious complication of diabetic
ketoacidosis (DKA) in children. The cause of cerebral edema during DKA is not well
understood. Recent studies suggest that it may result from lack of adequate blood flow to
the brain during DKA, before treatment starts. Brain injury, resulting in edema, may occur
before treatment because of lack of adequate blood flow to the brain and additional injury
may occur when adequate blood flow is re-established during treatment (called reperfusion
injury). Because additional injury may occur during treatment, it is important to
understand whether the rate of administration of intravenous fluids, and, therefore, the
speed of reperfusion of the brain, is related to the degree of brain swelling and injury.
Most current treatment protocols indicate that intravenous fluids should be administered
slowly, but it may be possible that brain injury and swelling might be lessened if adequate
blood flow is established more quickly.
In this study, researchers will use magnetic resonance (MR) imaging to compare two different
rates of fluid administration during DKA treatment in children. The investigators will use
MR imaging to measure brain swelling and metabolism at three time points—twice during
treatment and once after recovery from DKA—and will compare these measurements to determine
which fluid administration rate has more beneficial effects on brain metabolism and brain
swelling.
The study's researchers hypothesize that more rapid re-establishment of blood flow to the
brain (via more rapid administration of intravenous fluids) will result in less brain
swelling and injury than slower rehydration with delayed re-establishment of adequate brain
blood flow will.